Expanded Medicare coverage of PET draws kudos from oncology community

Highly expensive imaging technologies are a lightning rod in today’s contentious healthcare landscape. Critics contend that imaging services are grossly overused, while supporters argue that proper use of imaging saves lives and reduces downstream cancer costs.

Imaging proponents just won a skirmish in this ongoing battle of dollars and data. In early April, CMS issued a national coverage decision (NCD) that further expanded coverage for PET scanning as a cancer diagnostic tool under its Coverage with Evidence Development project. The decision was based, in large part, on evidence from the National Oncologic PET Registry (NOPR).

Now all Medicare beneficiaries with certain cancers will be covered for at least one PET scan. The nine currently covered cancers-breast, cervix, colorectal, esophageal, head and neck, lymphoma, melanoma, non-small-cell lung, and thyroid-have been expanded to cover the subsequent treatment strategy in addition to initial diagnosis.

Moreover, Medicare expanded coverage to include ovarian cancer and myeloma, making a total of 11 indications covered for both the initial diagnosis and subsequent treatment strategy for patients.

Oncology News International checked in with oncologists to discuss how the CMS decision will advance cancer diagnosis and treatment.

Still under review
The official word from ASCO is mixed. Joseph S. Bailes, MD, ASCO chair of government relations, said the society is in the process of analyzing the NCD. ASCO participated in the initial development of NOPR. “We are pleased with the early results from NOPR, showing that for initial staging, PET altered therapy in 36% of cases,” Dr. Bailes told Oncology News International. However, Dr. Bailes noted that “ASCO commented in February to CMS about our serious concern regarding the proposed criteria for clinical trials involving PET. We recommended deletion of these criteria because we feel they would have a negative impact on accrual. It remains an ongoing issue.”

More routine use of PET
Jay Cooper, MD, director of New York’s Maimonides Cancer Center, said that information from fused PET/CT studies has been part of the standard of care since his institution opened in 2005. Benefits include an improved ability to stage tumors and direct treatment, he explained, especially when tumors have spread to unexpected locations that can substantially alter therapy. “I expect the CMS decision will allow physicians to use this modality more routinely, thereby improving staging and therapy and, despite the initial cost, possibly saving money in the long run,” Dr. Cooper said.

Industry perspective
Developers of hybrid imaging technologies contend that using PET, in conjunction with other diagnostic exams, will allow physicians to adjust treatment during therapy rather than after the fact.

According to Ron Petrocelli, MD, chief medical officer, molecular imaging at Siemens Healthcare, the CMS decision is a step in the right direction. “But we need to use PET/CT for diagnosis, staging and for follow-up,” he said. “We need the ability to use whatever modality will get us the best treatment results for each patient.”

Dr. Petrocelli said that the onus falls on the imaging community to look at what tests, or combination of tests, would be most effective for patients. “The benefit of using PET/CT is that, despite the absence of a physical change in the tumor, the tumor may indeed be responding to therapy. PET/CT has the ability to show us those changes,” he said.